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� ' CITY OF ORONO <br /> * 2 0 1 6 - 0 0 5 9 4 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: OS/3U2016 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br />� <br /> ADDRESS : 945 FOREST ARMS LA <br /> PiN : 07-117-23-12-0019 <br />� LEGAL DESC : FOREST ARMS COUNTRY CLUB ADDN <br /> : LOT 000 BLOCK 002 <br /> PERMIT TYPE : SPRINKLER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : LAWN SPRINKLER <br /> ACTIVITY : BACKFLOW DEVICE <br /> NOTE: BACKFLOW DEVICE: PVB <br /> 2015 APOLLO-MODEL PVBA4A-F1 <br /> 36 ROTORHEADS-2.5 GPM PER HEAD-4 HEADSPER ZONE <br /> APPLICANT SPRINKLERS 50.00 <br /> STATE SURCHARGE FLAT-OTHER 1.00 <br /> AQUA ENGINEERING MAIL-IN FEE 2.00 <br /> 6561 CITY WEST PKWY <br /> EDEN PRAIRIE,MN 55344 TOTAL 53.00 <br /> (612)941-1138 Payment(s) <br /> CREDIT CARD 5363 53.00 <br /> OWNER <br /> EATON,ROBERT&JENNIFER <br /> 2721 COMSTOCK LA N <br /> PLYMOUTH,MN 55447- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be performed according to <br /> the approved plans and specifications,applicable City approvals,and the <br /> State Building Code. This permit is for only the work described and does <br /> not grant permission for additional or related work which requires separate <br /> permits. All provisions of laws and ordinances governing this type of work <br /> shall be compied with whether or not specified herein.This permit will <br /> expire and become null and void if construction authorized is not <br /> commenced within l80 days of the date of issuance,or if construction is <br /> suspended for a period of 180 days at any time afrer work has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> !---' j • <br /> /,_. , / <br /> � r����LL���� � �-� � �� l � l � <br /> Applicant Permitee Signature Date Issue B Signature Date <br />